Provider Demographics
NPI:1043771645
Name:BEAR RIVER SPINE CENTER, PLLC
Entity Type:Organization
Organization Name:BEAR RIVER SPINE CENTER, PLLC
Other - Org Name:PRECISION MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VERNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-799-7955
Mailing Address - Street 1:630 E 1400 N STE 115
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2691
Mailing Address - Country:US
Mailing Address - Phone:435-799-7955
Mailing Address - Fax:
Practice Address - Street 1:630 E 1400 N STE 115
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2691
Practice Address - Country:US
Practice Address - Phone:435-799-7955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty